Provider Demographics
NPI:1578962833
Name:JENSEN, SIGRID VALENTINE (MFT)
Entity Type:Individual
Prefix:
First Name:SIGRID
Middle Name:VALENTINE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 PIER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5360
Mailing Address - Country:US
Mailing Address - Phone:310-740-7505
Mailing Address - Fax:
Practice Address - Street 1:185 PIER AVE #104
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5360
Practice Address - Country:US
Practice Address - Phone:310-740-7505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81076106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist